CT assessment of right heart anatomy across tricuspid regurgitation severity grades: implications for transcatheter...

A five-grade severity scheme has been introduced for echocardiographic grading of tricuspid regurgitation (TR). Although higher TR grades have been associated with worse prognosis, it is unknown whether they can help determining patient eligibility for transcatheter tricuspid valve interventions (TTVI) and correspond to different anatomical phenotypes. The aim of our study was to investigate the relationship between TR severity and tricuspid valve (TV) anatomy and determine the screening failure rate for TTVI.

The anatomy of TV, right heart and venae cavae in patients with significant TR having undergone cardiac CT scan, was investigated using 3-mensio software and correlated with TR severity determined by echocardiography.

One hundred patients from two tertiary centers were retrospectively included into the present analysis. Nine patients had moderate, 40 severe, 22 massive and 29 torrential TR. Pre-screening eligibility assessment showed comparable screening failure rates among patients with severe, massive and torrential TR for the Cardioband (35.0% vs. 40.9% vs. 34.5%, p = 0.79), TricValve (50.0% vs. 63.6% vs. 55.1%, p = 0.27), EVOQUE (30.0% vs. 27.3% vs. 31.1%, respectively, p = 0.84), Cardiovalve (50.0% vs. 36.4% vs. 44.8%, p = 0.37) and LuX-Valve (20.0% vs. 27.3% vs. 24.1%, p = 0.26) systems. No significant differences in CT-derived tricuspid annulus area, perimeter and diameter were observed between patients with severe, massive and torrential TR, while right atrium (p < 0.001) and right ventricle length (p = 0.014) significantly increased with progressive TR severity.

CT imaging evaluation suggests similar eligibility rates for current TTVI devices and comparable TV anatomical phenotypes between patients with severe, massive, and torrential TR.